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10 Essential Tips for Navigating Obamacare

If you’re shopping for health insurance and your state built its own exchange, you might be very happy (Kentucky and New York, generally) or sort of happy (Oregon, where paper forms are now being used). If your state left the job to the feds – meaning you are consigned to healthcare.gov with its tech problems – you are most likely less happy.

Don’t worry: you’ve got some time. Decisions should be made by Dec. 15 for coverage beginning Jan. 1.

1. Do your homework. Get your information from an unbiased source, and from someone who’s not trying to sell you something. Some of the news coverage is wrong, and a lot of the private-party and big-company information tools may malfunction, or simply point you toward a purchase of the big company’s products. They ask you to give up a lot of info (on the United HealthCare site, for example, email, family details, medical history) and give you vague info in return. Some of the “decision support” tools direct you into plans but can’t calculate a subsidy, or don’t suggest other insurers’ products.

2. Figure out if you qualify for a subsidy. The Kaiser Family Foundation made a great subsidy calculator to help you understand whether you qualify and how much it might be. It works like a charm … but are the numbers correct? Hard to say, since many people have not yet chosen a plan or written a check. The healthcare.gov site says these are rough estimates.

3. Planning to go without insurance, or wondering if you should? Understand that there will be penalties. There are some great calculators online to help you figure out what those penalties will be, depending on if you’re an individual or if you have a family.

4. Do you have cancer or some other serious illness? It’s important if you have a serious illness like cancer or HIV/AIDS that requires continual care that you do some serious research on the care you’re currently getting and how changing your coverage could affect your costs and even which doctors you can go to.

5. Find your state’s exchange. Not sure where your state’s exchange is? You can find it by going to the federal site.

6. Want to know the premium rates in your state? Kaiser Health News has links to the individual state exchanges, with rates, and also a link to the healthcare.gov listing of premiums for the 36 states where the federal government is running the exchange.

7. Living in a state where you’re dependent on healthcare.gov and feeling that you’re in the dark? Don’t lose hope. Many of us in states where the exchange is functioning are finding that prices and coverage are much better than before on COBRA or on the private market. Example: I’m a head of household, nearing 60, with twin daughters, now 19. Our premiums on COBRA were $2,000 a month in New York about a year ago for pedestrian coverage and no pre-existing conditions. That’s what the private market looked like, too. After a period on insurance from a part-time job, I’m again insuring myself, and looking on the exchanges, am finding premiums to be much lower. On the other hand, Charlie Ornstein at ProPublica wrote about a couple in California who found their premiums to be higher ($1,300 instead of $550 for the two), their deductible to be higher ($4,500 instead of $4,000) and fewer options on the California exchange. As they say, your results may vary.

8. Don’t forget about the private market. If you don’t qualify for a subsidy, the private market (insurers who chose not to sell on the exchanges or comply with exchange rules) may be a good alternative.

9. There are many other subtleties. The New York Times told us, for example, that silver plans (the 2nd-lowest premiums) qualify not only for premium subsidies, but also for cost-sharing on co-pays, depending on income, meaning that might be your best option. Read the fine print!

10. A lot of people actually qualify for free or nearly free insurance because of government subsidies. A recent series of reports says that as many as 7 million people might qualify, though it varies greatly from state to state. You can compare subsidy levels state by state.

A Few Experiences With Health Insurance Shopping

Didn’t sign up yet? You’re not alone. A new study from the Commonwealth Fund on the first month of the exchanges says just one in five visitors to healthcare.gov or the state marketplaces actually enrolled in a plan in the first month. Of those who did not enroll, 37% cited technical difficulties as a reason, 47% said they weren’t sure they could afford a plan, 46% said they were still trying to decide, and 42% said they thought the copays and deductibles are too high. “A majority of survey respondents, however, appear determined to gain coverage over the next few months,” the survey added.

My friend Casey Quinlan, known as ”the Mighty Mouth,” and author of “Cancer for Christmas,” is a very web-savvy and well-informed resident of Virginia, where healthcare.gov is the only choice. She reports that she couldn’t use the site with the Chrome browser. She also reports:

Discovering that most of the “get more information” linkage leads to what amounts to a feedback loop. If you contact the plans, they direct you back to Healthcare.gov and the toll-free number. Detailed plan info is hard to get. The Anthem plans I looked at had NO, I repeat NO, plan details available on their site. Page said “this content is not here.”

The process itself, once you get in, is pretty easy to navigate, web-wise, but there are a host of (as mentioned above) yet-unanswered questions.

I have enrolled in a plan, but have heard nothing from either HHS or the plan itself (Coventry/Bon Secours Carelink) since. Still no bill for 1st month’s premium.

Casey, who has been uninsured since she completed treatment for breast cancer in 2008, added: “Overall, as a sophisticated and experienced health insurance consumer who has purchased individual and small business plans in the past, I’m left wondering how someone with no experience shopping for health insurance will navigate the process and wind up with something they’re happy with …”

My friend Nick, who went through healthcare.gov, said: “Biggest issue I found was that there’s no way to see a real side-by-side comparison of plan details. In some cases, the site will pass you to a specific carrier’s site to see plan details. In many cases, the URL redirect didn’t work. That said, I was still able to find a plan where my providers were in network and the out-of-pocket expenses were within my bounds.”

As for me, a New Yorker, where the state-run exchange is my choice, I’m pretty much OK. I haven’t chosen yet, but feel sure I’ll have the tools to do so.